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Are mixed germ cell tumors treated as seminoma or nonseminoma?

Nonseminoma

1

What are the risk factors for germ cell tumors?

Abdominal and inguinal cryptorchidism, spermatic or testicular dysgenesis, and family history. Klinefelter syndrome is a risk factor for mediastinal germ cell tumors.

2

T or F: If testicular ultrasound is abnormal, biopsy should be performed.

False. A radical inguinal orchiectomy should be performed. A biopsy is contraindicated because the normal vascular and lymphatic drainage would be disturbed.

3

What are the nonseminoma histologies?

Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac or endodermal-sinus tumors.

4

Does an abnormal serum AFP level indicate a seminoma or nonseminoma?

Always nonseminoma.

5

What are the adverse factors of germ cell tumors?

Mediastinal primary site; degree of elevation of AFP, HCG, LDH; nonpulmonary visceral mets

6

What is the treatment for stage I seminoma?

Radical inguinal orchiectomy. Afterwards, options include: surveillance, radiation to the para-aortic nodes, or a single dose of carboplatin. XRT is contraindicated if IBD or horseshoe kidney.

7

Treatment for stage IIA seminoma?

Radiation.

8

Treatment for stage IIB seminoma?

Chemotherapy or radiation.

9

Treatment for advanced seminoma?

Chemotherapy. After 6 weeks, get PET CT. If pos, consider surgery.

10

Adjuvant treatment for stage I nonseminoma?

Stage IA: close surveillance. High-risk IB (embryonal predominant, lymphatic, vascular, scrotal, spermatic cord invasion): nerve sparing RPLND.

11

Adjuvant treatment for stage II nonseminoma?

First, RPLND. Then, if N1 (pos node 2 cm or > 5 involved nodes or extranodal extension) chemo for 2 cycles. If N3 (node > 5 cm), chemo for 3 or 4 cycles. If serum markers do not normalize, surgery.

12

Treatment for advanced germ cell tumor?

Good risk: cis/etop x 4 or BEP x 3. Intermediate risk: BEP x 4. Poor risk: BEP x 4.

13

Salvage therapy for germ cell tumors?

Vinblastine/ifos/cis, TIP (paclitaxel, ifos, cis), cis/epirubicin. If these fail, consider high-dose chemo with peripheral stem cell rescue.

14

After chemo for germ cell tumors, if we have residual radiographic abnormalities but normal serum tumor markers, what should we do next?

Surgery.

15

Which cancers can a teratomatous component of a nonseminoma transform into?

Rhabdomyosarcoma, adenocarcinoma, primitive neuroectoderm tumor, and leukemia.

16

T or F: bladder cancer is more common in men than women, whites than blacks.

T

17

Risk factors for bladder cancer?

Smoking, occupational exposures, urinary tract diseases, drugs.

18

T staging for bladder?

Ta: noninvasive papillary lesions.
Tis: carcinoma in situ
T1: invades the subepithelial connective tissue
T2: invades muscle
T3: invades perivesical tissue
T4: invades prostate, uterus, vagina, pelvic, abdominal wall

19

Treatment for non-muscle-invasive bladder cancer?

Transurethral resection. Intravesical BCG x 6 weekly doses for T1, Tis, and recurrent or multifocal Ta. Other agents: mitomycin C, gem, doxorubicin, valrubicin.

20

Treatment for muscle-invasive bladder cancer?

Neoadjuvant with cis/gem for certain patients, then radical cystectomy with bilateral pelvic lymphadenectomy. No definitive data on adjuvant chemo. A bladder preservation approach using transurethral resection, radiation, chemo can be considered.

21

Treatment for metastatic bladder cancer?

MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and cis/gem. Both regimens are similarly efficacious.

22

Risk factors for RCC?

Smoking, obesity, hypertension, acquired cystic kidney disease

23

Treatment for localized RCC?

Nephrectomy. No benefit to adjuvant radiation.

24

What is Stauffer syndrome?

Signs and symptoms of hepatic dysfunction in patients with localized RCC.

25

Is there a role for cytoreductive nephrectomy in metastatic RCC?

Yes. Combined with system therapy, it can prolong OS.

26

Histologies of RCC?

Clear cell, papillary (more favorable than clear cell), chromophobe (indolent), and collecting duct (very aggressive).

27

What is Von Hippel-Lindau disease?

RCC, retinal angiomas, hemangioblastomas of the spinal cord and cerebellum, pheochromocytomas. VHL promotes the ubiquitination and destruction of HIF-alpha.

28

Systemic therapies for metastatic RCC?

Bev > placebo. Bev + IFN > IFN alone. Sunitinib > IFN. Pazopanib > placebo. Pazopanib ~ sunitinib (pazo has better QOL). Sorafenib > placebo. Sorafenib ~ IFN. Temsirolimus > IFN. Everolimus > placebo. Can also consider IFN and IL-2.

29

How many men will develop prostate cancer in the United States?

One in six